PART II NOT FOR SALE OR DISTRIBUTION Major Nutrients

Major Nutrients

PART II

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© Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION.

© Jones & Bartlett Learning, LLCNOT FOR SALE OR DISTRIBUTION




















21

“I love being active and mentally present and aware. Therefore, I love carbs as they are what give me the energy I need to do all the things that I love to do. Choosing the right kind of carbohydrates allows me to get the most out of my day.”

Cameron Diaz—Actress

Carbohydrates

Learning Objectives

● Name both chemical and nutritive classifications of carbohydrates

● Discuss the molecular difference between a monosaccharide, disaccharide, and polysaccharide

● Explain the digestion of carbohydrates in the body

● Describe maintenance of blood glucose level and outline the steps involved in reducing excess blood glucose and releasing glucose when the level is low

● Differentiate between an insoluble fiber and soluble fiber● Explain what happens in the body when carbohydrates are restricted from the diet

● Give examples of foods that are rich in fiber and discuss their importance in the diet

● Counsel patients about the benefits of carbohydrates in the diet and guide them to choose those that are complex versus simple

Key Terms

AmyloseAmylopectinComplex CarbohydrateFiberGlycemic IndexGlycogen

HomeostasisHyperglycemiaHypoglycemiaInsoluble FiberKetosisRoughage

2























22 Part II Major Nutrients

SatietySimple Sugar

Soluble FiberSpiking

INTRODUCTIONWhat is a carbohydrate?

If you answered “sugar,” you would be half right. Carbohydrates are a type of sugar, but all carbohydrates are not sweet like that which you put in coffee or tea. Rice, pasta, bread, fruits, and vegetables are also carbohydrates. The size of the chemi-cal arrangement is what determines the flavor and level of sweetness, but they all do pretty much the same thing for the body. And that is to provide fuel for your furnace.

Before the Industrial Revolution (1760–1840), foods most readily available for con-sumption were rich in carbohydrates and, therefore, the main source of nutrients for humans on the planet. Geographic regions each had their signature staple food that grew well on their land. These foods were consumed in the whole or natural form and were nutrient dense with vitamins, minerals, and fiber. Table 2-1 identifies the food staple by region.

The Industrial Revolution was a very creative time for man. Many machines were invented including those that refined wheat, sugarcane, and sugar beets into a fine pow-der. To get the fine white powder, the husks and pulp had to be removed. It was later learned that husks and pulp were the most nutritive part of the plant. Since the best part was removed (nutrients and fiber), the powdery flour and sugar lost nutritive value but retained calories. It was considered a luxury and a display of wealth to have a pan-

try full of bleached white flour and sugar. What once were wealthy sources of nutrients became poor sources, but their consumption remained the same. People began to prepare their food with

Region Food

Asia RiceMiddle East WheatGreat Britain Barley and oatsPacific Islands Taro rootAfrica Cassava root and yamsAmerica Potatoes and cornSouth America QuinoaCentral America Corn and rice

Table 2-1 Main Food Staples by Region

Almost one third of calories in the American diet are from refined sugar and corn syrup.























Chapter 2 Carbohydrates 23

refined ingredients, and this led to the occurrence of obesity in people of wealth and position. Because of this refined flour and sugar/obesity connection, carbohydrates got a bad reputation of being fattening. This is erroneous thinking as all carbohydrates are not bad or unnecessary. The right kind of carbohydrates, when carefully selected, is an excellent low-fat source of fiber and nutrients.

CARBOHYDRATES IN THE ECOSYSTEMWith the exception of one sugar, plants are the source of all carbohydrates. Figure 2-1 illustrates where carbohydrates fit into the food chain.

1. Plant roots absorb water.2. Foliage absorbs carbon dioxide (CO2) from the air.3. Plant absorbs rays from the sun.4. Chloroplasts in the plant take all three—H2O, sun, and CO2—and through

photosynthesis make monosaccharides.5. Animals eat the plant and reduce the monosaccharides to glucose.

PRIMARY ROLE OF CARBOHYDRATES IN THE BODYCarbohydrates are an important component of a balanced diet. Provided by most foods, especially grains, fruits, and vegetables, they are the most prolific source of energy for the body. The primary roles of carbohydrates are to:

Grits are an indigenous carbohydrate-rich grain of the American southern states. The process for making hominy grits was learned from Native Americans. The same process is also used in the process of making Mexican tortillas.

Dried maize (corn) kernels are soaked in lye, which makes hominy. Ground-up hominy is used to make grits.

Lye = sodium hydroxideWait a minute… sodium hydroxide is in drain cleaner, good for dissolving hair

and skin.No worries… hominy is soaked in a weak solution of lye to soften and

breakdown the husks and then thoroughly soaked and washed to remove the lye. Once dry, it is ground up into a course powder.

A SOUTHERN FOOD STAPLE: WHERE DO BELOVED SOUTHERN AMERICAN GRITS COME FROM?

FOOD FOR THOUGHT

Lactose (milk sugar) is the only carbohydrate of animal origin.
























● Supply the body with energy● Maintain blood glucose levels● Continue brain and nervous system function, even while sleeping● Spare protein so the body does not burn dietary or body fat and protein for energy● Help burn fat for fuel● Provide bulk in the diet (fiber) and gives a sense of satiety (feeling full)

CLASSIFICATION OF CARBOHYDRATESThe word carbohydrate is Latin for hydrated water. Carbohydrates are often abbrevi-ated CHO, which identifies three comprising elements:

Carbon Hydrogen Oxygen

The chemical building blocks of CHOs are called monosaccharides, which are com-posed of:

(C6H12O6)6 carbon 12 hydrogen 6 oxygen atoms

Carbohydrates can be classified in two ways: either chemical or nutritive.The chemical classification helps us understand how the molecules of carbohy-

drates link together, and the nutritional classification determines their value in our diet.Table 2-2 outlines these two classification systems.

Glucose

CO2

CO2

fiber

Energy

MilkSugar

Water

Animal fats

Carbohydrates

Solarenergy

Carbon dioxide(CO2)

sugarsstarches

Figure 2-1 The carbon cycle.
























Chemical Classification of Carbohydrates

The main unit of carbohydrate is a monosaccharide (glucose molecule). One mol-ecule of glucose consists of 6 carbon atoms, 12 hydrogen atoms, and 6 oxygen atoms: C6H12O6. Figures 2-2 and 2-3 illustrate the chemical structures of monosaccharides and disaccharides, respectively.

1. Monosaccharide = 1 molecule of sugar2. Disaccharide = 2 molecules of sugar3. Oligosaccharide = 2 to 10 molecules of sugar4. Polysaccharide = more than 10 molecules of sugar

Nutritional Classification

Simple Sugars

Monosaccharides and disaccharides are referred to as simple sugars and are usu-ally those that are sweet to the taste. Candy, cookies, cake, soda, ripe fruits, and other baked goods fall in this category and are high in calories but lack the nutrients

CH2OHCH2OH

CH2OH

CH2OH

C

CC

C C

C

C

C C

C

OOH

C

C C

H

HH

H

C

O

Glucose Fructose Galactose

OH

H

HHOH

OHOH

OHOH

OH

OH

OH

OH

H

H

HHH

H

Figure 2-2 Chemical structure of monosaccharides.

Chemical Nutritional

Monosaccharide Simple carbohydrateDisaccharide —Oligosaccharide Complex carbohydratePolysaccharide —

Table 2-2 Classification of Carbohydrates
























supplied by complex carbohydrates. Lactose (found in dairy products) and glucose (blood sugar) are also considered simple sugars but are not sweet to the taste.

Monosaccharides = One

Glucose is also called dextrose or blood sugar. It is the main agent for the body’s fuel source that supplies energy to the body. Most other sugars are either converted or broken down to this single unit as it is small and soluble in water and can pass through cell membranes. Glucose can be stored as glycogen in muscle and the liver, or if con-sumed in excess, can be converted to fat for future energy supply.

CH2OH

CH2OH

CH2OH CH2OH

CH2OH

CH2OH

CH2OH

C

C

C C

C C C

CC

H

Sucrose

Maltose

Lactose

HO

HH

H

H

H

HO

OH

H

H

C

C

C

C

C

C

C

C

C

C

C

H

H

HOH

OH

HH

HH

H

H

H

OH

OH

OH

C

C

O

C

C

H

HO

HO

OH

OH

OH

OH

OH

H

H

H

HH

H

H

H

HO

O

OH

OH

O O

O

C

C

O

O

CC

O

C

Figure 2-3 Chemical structure of disaccharides.
























Disaccharides = Two

Most sugars found in nature are disaccharides, which are two monosaccharides together. Unlike monosaccharides, they are too big to pass through cell membranes so are broken down to monosaccharides for use by the body. Some examples are as follows:

1. Sucrose, common table sugar, consists of one glucose and one fructose molecule, which gives our food the sweet taste.

2. Maltose consists of two glucose molecules and is created when larger car-bohydrate molecules are broken down during digestion.

3. Lactose, the sugar found in milk, splits into the two monosaccharides glu-cose and galactose during digestion.

Complex Carbohydrates

Polysaccharides are referred to as complex carbohydrates and are the most nutrient dense of all carbohydrates providing vitamins, minerals, fiber, and water to the body. Grains with their husk intact like brown rice, whole grain bread, cereal, whole wheat pasta, legumes, fruits, and vegetables are foods rich in complex carbohydrates.

Table 2-3 lists common monosaccharides, disaccharides, and polysaccharides.Figure 2-4A shows examples of simple and complex carbohydrates; Figure 2-4B

shows examples of low nutrient simple carbohydrates (Table 2-4). Table 2-4 gives examples of complex carbohydrate substitutions for simple carbohydrates.

MONOSACCHARIDES

• Glucose—blood sugar• Fructose—fruit sugar• Galactose—milk

DISACCHARIDES

• Sucrose: glucose + fructose = table sugar• Maltose: glucose + glucose = flavoring, breakdown product of starch• Lactose: glucose + galactose = milk disaccharide

POLYSACCHARIDES

• Oligosaccharide• Starch• Glycogen

Table 2-3 Common names for chemical classification of carbohydrates
























Oligosaccharides

Oligosaccharides are a unique type of carbohydrate because the body does not metab-olize them in the usual way. They are larger than a disaccharide—at least two or more single sugar molecules—and are found in legumes (beans). Oligosaccharides pass

A BFigure 2-4 A: Examples of simple and complex carbohydrates. (Complex on left, simple on right: Photo courtesy of Kevin Brown, Zolfo Springs, FL.) B: Examples of low-nutrient simple carbohydrates—empty calories. (Photo courtesy of Kevin Brown, Zolfo Springs, FL.)

Simple Carbohydrate Complex Carbohydrate

White bread Whole grain breadWhite rice Brown riceSemolina pasta Whole wheat pastaSugar-sweetened juices 100% fruit juice and vegetable juiceFlour tortillas Wheat or spinach tortillas

Table 2-4 Simple Carbohydrates versus Complex Carbohydrates
























through the stomach undigested into the intestines, where bacteria feed on the car-bohydrate and create a gaseous end product, giving beans their unpleasant reputation.

Starch

Starch is the storage form of energy in plants, just as glycogen is the storage form of energy in animals (and man). The arrangement of glucose molecules determines whether the starch is amylose or amylopectin, the two most predominant starches.

Amylopectin is a series of highly branched chains of glucose molecules. It is some-times referred to as a waxy starch that forms a stringy paste when heated, and this property makes it work well as a thickener in food. Amylose is composed of thousands of straight-chain glucose molecules. Foods that contain starch are grains, legumes, tubers (potatoes, yams, and turnips), and some fruits.

Starch is used as a thickening agent in cooking and baking. A good example is cornstarch: when mixed with water over heat, it forms a sauce or gravy. When we con-sume starch, it gives us a sense of satiety or fullness, and the sense of being full stays with us for a longer period of time.

Glycogen

Glycogen is the most highly branched chain of glucose units and is the storage form of carbohydrates that is found in the liver and muscle.

In Liver—helps maintain blood glucose levelsIn Muscle—provides quick supply of energy for working muscles

Fiber

Fiber is the ingredient in food that is usually referred to as roughage or bulk and is not used by the body for energy. Fiber is thousands of glucose units bonded together and is

found exclusively in plants, which give them struc-ture. A good example of fiber are stringy strips that run the length of celery and skin on a apple.

One way to tell if a food contains starch is to add a drop of iodine. The unbranched helical shape of amylose reacts strongly to iodine and turns it blue-black. Amylopectin, cellulose, and glycogen will turn the iodine reddish-purple and brown.

EXPERIMENT WITH YOUR FOODFOOD FOR THOUGHT

Fiber in plants is equal to bones in animals.
























Humans do not have enzymes that can break down and digest fiber. The chemical links between fiber molecules are joined in such a way that they cannot be separated by human digestive enzymes. Vitamins and minerals in fiber-rich foods are not made available to the body and pass through unabsorbed. See Figure 2-5 for an illustration of enzyme activity. There are two general classes of fiber, and most foods contain both types—some have more soluble than insoluble. It is good to include both types in your diet as fiber feeds healthy bacteria that lives in the colon.

Soluble Fiber—dissolves in water.Some examples of food high in soluble fiber are as follows:

● Black, kidney and navy beans● Flaxseed● Apricots, grapefruit, mangoes● Turnips and sweet potatoes● Oatmeal and oat bran

Function of Soluble Fiber

● Adds chewy or crunchy texture to foods● Gives a sense of satiety—keeps the stomach full longer● Stabilizes blood sugar—takes longer for the body to metabolize and slows release of glucose into bloodstream

● Helps lower cholesterol—binds fiber and carries it out of the body in waste

Glucose

Glucose

Starch

Glycogen Fiber

Glucose

Glucose

Glucose

GlucoseGlucoseGlucose

Glucose

Glucose Glucose

Glucose

Glucose Glucose Glucose

Figure 2-5 Enzymes cannot break apart fiber.
























Insoluble Fiber—does not dissolve in water and passes through the body undigested.

Some examples of food high in insoluble fiber are as follows:

● Whole grains, brown rice, bran● Corn, broccoli● Dark leafy greens● Skin on fruits and vegetables● Seeds and nuts

Function of Insoluble Fiber

● Prevents disease by stimulating peristalsis and keeps colon muscles exercised and strong

● Decreases constipation● Prevents hemorrhoids● Prevents colon cancer—empties the colon so that the lining of the intestines and colon are not exposed to toxins for a long period of time. Think of undi-gested insoluble fiber scouring your intestines

● Decreases incidence of appendicitis

Table 2-5 lists the grams of the different types of fiber found in certain foods. When increasing the amount of fiber in your diet, do so gradually to allow your body time to adapt. Increasing the amount too fast will result in waste elimina-tion problems. Drink plenty of fluids to keep stools hydrated, allowing for less constipation.

Food Total Fiber Soluble Fiber Insoluble Fiber

Oat bran 28 14 14Rolled oats 14 8 6Wheat bran 43 3 40Kidney beans 10 5 5Pinto beans 11 5 6Corn 3 2 1Apple 2 1 1Orange 2 1 1

Table 2-5 Grams of Fiber in Food
























Modern man consumes on average 8 g of fiber per day. Our hunter–gatherer ancestors consumed close to 100 g/day because of diets rich in roots/tubers, grass/plants, and berries with seeds. Although it is hard to know for sure, researchers affirm that our ancestors were free of many of the diseases that affect modern man—cancer, heart disease, diabetes, and obesity. Paying attention to amount of fiber you consume on a daily basis and including more fiber-rich foods if deficient will improve your risk of common diseases.

When bacteria in the stomach are processing fiber, one of the by-products is short-chain fatty acids. Butyrate is a fat-chain fatty acid shown to have the ability to turn on an anticancer gene, which greatly reduces the risk of colon cancer—by about 30%.2,3

MAINTENANCE OF BLOOD GLUCOSE HOMEOSTASISA healthy blood glucose level is 80 to 100 mg/dL of blood. When blood glucose is higher, you have hyperglycemia (over). When blood glucose is lower, you have hypoglycemia (under).

Insulin and glucagon are the two hormones involved in keeping your blood glu-cose at an optimal level. When blood glucose level is too high or low, your sense of well-being is disturbed. If your body is circulating too much blood glucose, you feel an excess of energy and are nervous and excitable. When there is not enough blood glucose, you can feel lethargic, disoriented, and confused. Maintaining the right amount of glucose in the blood is called homeostasis. When the amount of glucose in your blood is in balance with what your body needs, there is an overall sense of well-being and you feel just the right amount of energy and alertness. Table sugar and foods rich in simple sugars will overdose your system with glucose, giving you the feeling of both extremes in a short period of time. This is called spiking (loading our bodies with sugar) and is a harmful pattern. You feel a rapid surge then subsequent decline in energy over a short time span. When you feel the drop in energy, the first inclination is to eat a candy bar or drink a soda to feel energetic again. This behavior

Dr. Denis Burkitt was an Irish physician who sought to discover why geographic areas had different incidence and distribution of cancer. He hypothesized and studied the causal relationship between gastrointestinal diseases and low-fiber diets. For more in-depth reading, access the biographical article in the Journal of Nutrition by Jon A. Story and David Kritchevsky.1

CAN LOW FIBER DIETS CAUSE GI DISEASE?FOOD FOR THOUGHT
























greatly increases the amount of calories ingested (with no nutrients) and lends itself to detrimental long-term effects such as obesity and dental caries. Homeostasis works as follows and is illustrated in Figure 2-6:

Too much glucose in the blood stream: You are feeling jittery, anxious, hyperactive.

Receptor cells in the pancreas recognize that there is more glucose in the blood than the body currently needs for energy. The pancreas secretes the hormone insulin, which draws out the excess glucose, thus reducing the amount of blood glucose when the level gets too high. It attracts glucose from the bloodstream and stores it in the muscle and the liver where it is converted to glycogen (storage form of glucose). The glycogen stays in the muscle until the body needs it to move the muscle, or stores it in the liver for future energy use. There is a limit to the capacity of glycogen storing cells. Once the stores are filled, the overflow is routed to fat. Unused adipose (fat) cells begin to enlarge and fill with fat, and the storage capacity is unlimited.

Not enough glucose in the blood stream: You are feeling sleepy, lethargic, low energy.

Receptor cells in the pancreas recognize that the body is in need of energy so the pancreas secretes the hormone glucagon, which converts the glycogen in the liver to

Pancreas

Lowbloodglucose

Normal

blood

glucose

Normal

blood

gluco

se

Pancreas

Glucagon

Liver

LiverFat

Fat

Fat cells

Glycogen

Food

Insulin

Muscles

Glycogen

Glycogen

Blood stream

Highblood

glucose

Figure 2-6 Blood sugar homeostasis.
























glucose and releases it into the bloodstream, where it is carried through the body and used for fuel.

How the Body Regulates Blood Sugar● Eating carbohydrates throughout the day will help maintain blood glucose levels. Eat a little with each meal.

● Whenever possible, choose the whole grain version of the food, because it is metabolized more slowly by the body.

● Avoid refined sugars—they are empty calories and cause spiking.

RECOMMENDED DIETARY INTAKEThere is no recommended dietary intake for carbohydrates, but it has been loosely recommended at 55% to 65% of total daily calorie intake, with 25 to 35 g being fiber. This amounts to about 300 g for a sedentary person and 500 g for a physically active person. It has also been suggested that we limit daily intake of refined sugar to less than 10% of total calorie intake, which includes the sugar present in processed foods like jams, jellies, baked goods, and beverages (2015 Guidelines for Health Americans). The average person consumes about 50 teaspoons of sugar each day including that which gets added to coffee, tea, and cereal, and that which is incorporated into recipes and processed foods. If you add that up, it is equivalent to a couple five-pound bags of sugar each month. According to the USDA Factbook Profiling Food Consumption in America, it is recommended you should have no more than 10 teaspoons a day, which is equivalent to slightly less than one can of soda.

Food manufacturers put sugar in just about all their products to stimulate appetite for more of the same. There are over 600,000 manufactured food products, and 80% of them contain sugar. The more you eat, the more you want.

Sugar addiction follows the same pattern as all other addictions—binge, withdrawal, craving. Studies conducted on lab mice showed that overtime, mice increased their sugar intake to twice the amount as at the beginning of the study. When sugar was withheld from them, they displayed signs of withdrawal like teeth chattering and body tremors. The mice needed to increase their intake to create the same initial feel-good effect.

IS THERE REALLY SUCH A THING AS A SUGAR ADDICTION?

FOOD FOR THOUGHT
























DIGESTION OF CARBOHYDRATESMonosaccharides do not require breakdown by enzymes, but disaccharides and polysaccharides must be reduced to monosaccharides by enzymes before they can be absorbed and used by the body. Polysaccharides are broken down to disac-charides, and disaccharides are broken down to monosaccharides. The s-p-l-i-t-t-i-n-g (or breaking apart) of molecules begins in the mouth when polysaccharides mix with salivary amylase and are reduced to disaccharides. Further degrada-tion happens when the reduced molecules come in contact with stomach acids. Disaccharides are passed into the small intestine, where pancreatic amylase com-pletes the breakdown to monosaccharides. These small monosaccharides then pass through the small intestinal villi into the bloodstream, where they travel to the liver for nutrient processing before being sent out to all parts of the body for use as energy.

● Sucrose is broken down by sucrase into glucose and fructose.● Maltose is broken down by maltase into glucose units.● Lactose is broken down by lactase into glucose and galactose.

GLYCEMIC INDEXGlycemic Index is a numeric ranking system for carbohydrates based on their imme-diate effect on blood glucose levels. Foods high in fats and protein do not cause the rise in blood sugar levels as do carbohydrates. Carbohydrates that break down rapidly to supply the body with glucose are at the high end of the index, and those that take longer to break down and digest are at the low end. Some people make the mistake of thinking that only simple carbohydrates are at the high end when, in fact, some

In another study, scientists genetically altered lab mice without sugar receptors. They provided two bottles of water—one with and one without sugar. After a few hours, the mice began drinking exclusively from the sugar water bottles. Then they added a bottle with Splenda, and they still preferred the sugar water. Since mice are unable to communicate why they preferred the sugar water, scientists analyzed their brains and discovered that the mice released dopamine in response to sugar water. They could not taste it, but it made them feel good. Their brains, like ours, are slaves to feeling good.

Jonah Lehrer—McGriddles: http://scienceblogs.com/cortex/2009/07the_neuroscienceo_of_mc-griddles.phpde Araujo O-M, Sotnikova G, Caron N, et al. Food reward in the absence of taste receptor signal-ing. Neuron 2008;57(6):930–941.
























complex carbohydrates are also at the high end. The lower the glycemic index (GI), the less demand for insulin and slower the digestion and absorption rates. The less the demand for insulin, the better the blood glucose control. People who are diabetic need to learn the glycemic value of foods in order to prepare meals that will allow for slower release of glucose into the blood stream.4,5 Some foods may surprise you where they fall on the spectrum. For example, a Coke has an index of 68, but Fanta Orange and Ocean Spray Cranberry juice cocktail also have 68. Athletes will appreciate know-ing that Gatorade has 78 and banana has 62. Foods that are low on the spectrum that do a better job of maintaining blood glucose are grapefruit with 25, carrots 35, pea-nuts 7, and hummus 6. For more on how to calculate glycemic index, visit www.dum-mies.com/how-to/content/how-to-calculate-glycemic-load.html. Another Web site www.health.harvard.edu has a table of glycemic index for 100 + foods. Tables 2-6 through 2-9 gives a few examples of GI for foods.

Wonder bread 73Kaiser Roll 73Whole wheat bread 71Whole wheat pita 57Sour dough 52Corn tortilla 52Dark rye 51Whole grain English muffin 45Wheat tortilla 30

Table 2-7 Glycemic Index for Bread

Low GI Medium GI High GI

Apples Beets PopcornCarrots Cantaloupe WatermelonGrapes Pineapple Whole wheat breadKidney beans Table sugar While flour and breadPeanuts White and wild rice Corn flakesLentils Sweet potatoes CheeriosCorn New potatoes Baked potatoes

Table 2-6 Glycemic Index (GI) of Foods (Glucose = 100)
























CAUTIONARY ADVICE ABOUT CARBOHYDRATES● Lactose intolerance, also referred to as milk allergy, occurs when there is an absence of the digestive enzyme lactase. Without lactase, the disaccharide lac-tose cannot be digested or absorbed. It passes undigested to the colon, where bacteria feed on the carbohydrate, resulting in cramping and diarrhea. People who are lactose intolerant must avoid dairy products or take lactase enzyme pills before consuming dairy products.

● Excessive fiber intake can decrease mineral absorption and cause cramping and gas. Be sure to increase fiber in the diet gradually and drink plenty of water.

● Carbohydrates are notorious for contributing to the development of dental caries with simple sugars being the most cariogenic. (See Chapter 9.)

Fruit roll up 99Pretzels (16) 83Doritos 72Microwave popcorn 72Chewy Granola Bar 61Snickers candy bar 55Potato chips (11) 54Peanut M&Ms (6) 33Oreo cookies 64

Table 2-8 Glycemic Index for Snacks

12-oz can of beer 15Red or white wine 158-oz glass whole milk 278-oz glass low-fat chocolate milk 4912-oz can Coke 686-oz glass orange juice 716-oz glass unsweetened apple juice 576-oz glass tomato juice 546-oz glass carrot juice 61

Table 2-9 Glycemic Index for Beverages
























● Excess consumption of simple carbohydrates can cause a temporary elevation in blood triglycerides, which can increase risk for heart disease.

● Loading up on simple sugars can cause blood glucose to spike and then drop below normal, causing a condition called rebound hypoglycemia.

CARBOHYDRATES ARE PROTEIN SPARINGCarbohydrates are called protein sparing. The function of protein in the body is varied but includes important tasks like creating antibodies, hormones, and building and repairing body tissue.(see Chapter 3). When the liver stores are depleted of glucose and carbohydrate consumption is restricted, the body will create needed glucose from amino acids found in protein through a process called glucogenesis.

CARBOHYDRATE RESTRICTIONCarbohydrates are needed for many metabolic functions. If a diet restricts intake of carbohydrates (low carb), there is minimal glucose available for the body to use for vital processes. If there is not enough glucose to perform vital metabolic functions, the liver will convert fat into fatty acids using adipose cells (fat cells). The rapid release

Lactose-intolerant people can substitute fruit juices fortified with highly absorbable calcium citrate or take calcium supplements to supply the body with the daily requirement of calcium.

Certain ethnic groups are more prone to lactose intolerance: Asians, Native Americans, African Americans.

LACTOSE INTOLERANCEFOOD FOR THOUGHT

Sugar is present in a wide array of processed foods, for example, cereal, canned food products, candy, and baked goods. Sometimes when you see it on a label, you wonder what it is doing in the recipe. The answer is: like salt, it can be used as a natural preservative because it pulls water from cells and disables bacteria. Most of the time, its taste is undetectable, as in canned goods, crackers, and processed foods.

SUGAR AS PRESERVATIVE IN MANUFACTURED FOODFOOD FOR THOUGHT
























of all these fatty acids creates incomplete breakdown in the liver leading to forma-tion of ketones. Glucose is the preferred energy source for all body cells, and ketones are the body’s crisis reaction to lack of carbohydrates. With ketones circulating, the body enters a physiologic state of ketosis, which is a response to fuel shortage. Acetyl groups are also made during the production of ketones, which will give breath a dis-tinctive acetone smell (fruity chemical odor).

Because our brain and heart need a steady supply of carbohydrates for proper functioning, a state of starvation will kick the body into survival mode, at which time it will use ketones for energy and brain and heart activity.

RELATE TO PATIENTSWhen providing nutritional counseling for a patient and his or her diet diary reveals a deficiency in the food groups that supply the most carbohydrates (breads and cere-als, dairy, and fruits and vegetables), encourage choosing and eating more complex versus simple carbohydrates. Some patients have difficulty making sudden switches or find that the more fibrous versions of bread, rice, etc., are less palatable. Suggest mixing simple and complex carbohydrates and gradually increasing the proportion of complex carbohydrates until they are able to make the change to healthier complex versions.

For example, you can suggest to your patient:

● Mix a few tablespoons of brown rice with white rice.● Mix whole wheat pasta with semolina pasta.● When preparing a sandwich, use one piece of white and one piece of whole grain bread, putting the white bread tongue side. Try the same with ham-burger buns, rolls, and crackers.

● To increase the servings of fruits and vegetables, drink juice instead of soda.● Add variety to meals with soft cooked and fresh vegetables.
























CHAPTERREVIEW

PRACTICE FOR PATIENTS

Patient #1

Your patient has rampant facial caries on her six maxillary anterior teeth. She states that she has a problem staying awake for a 12-hour shift at the hospital and drink-ing a soda every other hour helps her stay alert. In addition to dental caries, you notice her blood pressure is higher than normal and she was recently diagnosed with asthma.

1. Would you consider the soda to be a simple sugar or a complex carbohydrate?2. Give an explanation of what is happening in your patient’s body to cause the

cycle of low and high energy.3. Suggest a drink substitution that would give her blood sugar homeostasis.4. How does a diet high in simple sugars affect overall health?

Patient #2

Your patient is a night security guard at the local shopping mall. His food addic-tion is to fresh-baked doughnuts. Access to day-old doughnuts at the mall café is one of the job’s benefits. He states that he has gained about 25 pounds since taking the job 3 years ago but that is OK because his girlfriend says there is “more to love.”

1. Would you expect to find changes to his medical history? If so, what could be those changes?

2. Will his addiction to doughnuts affect the oral structures in any way?3. What home care advice should you be sure to include during patient

education?
























RELATE TO YOU

Assignment #1

Evaluate your food and drink consumption over the last 2 days and determine if added sugar was less than 10% of the total calories in your diet. If your intake was higher, what changes can you make to better maintain your blood sugar level?

Assignment #2

Evaluate the amount of fiber in your diet. It has been suggested that our diets include 25 to 35 g of fiber per day. Locate a chart of fiber content of certain foods and add up the amount consumed on a typical day.

1. Did you meet your goal?2. If not, how can you increase the amount of fiber in each meal?3. Explain the necessity for adequate fiber in your diet—how does it improve your

health?

Assignment #3

Spend a few days experimenting with different breakfast meals:

Using the chart from Chapter 1, complete the boxes an hour after your meal.On one of the days, eat a meal that you enjoy that is high in simple sugars.On another day, eat a meal that is rich with fresh fruit and complex cereal grains.Both meals are carbohydrate—one simple and one complex. Does your body and

mind know the difference?

REFERENCES

1. Story J, Kritchevsky D. Denis Parsons Burkitt (1911–1993). J Nutr 1994;124:1551–1554.2. Borges-Canha M, et al. Role of colonic microbiota in colorectal carcinogenesis: a

systematic review. Rev Esp Enferm Dig 2015;107(11).3. Hu S, Liu L, Chang EB, et al. Butyrate inhibits pro-proliferative miR-92a by diminishing

c-Myc-induced miR-17-92a cluster transcription in human colon cancer cells. Mol Cancer 2015;14(1):180.

4. Schulte EM, et al. Which foods may be addictive? The roles of processing, fat content, and glycemic load. PLoS One 2015;10(2):e0117959.
























5. Augustin LS, et al. Glycemic index, glycemic load and glycemic response: an international scientific consensus summit from the international carbohydrate quality consortium (ICQC). Nutr Metab Cardiovasc Dis 2015;25(9):795–815.

WEB RESOURCES

Consumer Fact Sheet: Sugar in Your Diet www.sbreb.org/brochures/FactSheet/Create your Plate for Diabetics http://www.diabetes.org/food-and-fitness/food/planning-

meals/create-your-plate/?loc=ff-slabnavSugar Sweet by Nature www.sugar.org/consumers/sweet by nature.asp?id=279























PART II NOT FOR SALE OR DISTRIBUTION Major Nutrients

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